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Breast Reductions with Implants

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In my Louisville Cosmetic Surgery practice I occasionally have a patient request a breast reduction with an implant placed. This really isn’t possible for a few reasons so I thought I would elaborate. After fielding this request several times, I asked why in the world someone would want to make their breasts smaller via the reduction then put an implant right back in. Seemed counter-intuitive. Well, what the patients were envisioning was having all of their breast tissue shelled out and then the skin tightened around the implant. The ultimate goal being a more firm, perkier breast.

It doesnt really work that way though.

When we do Breast Reductions we leave a central portion of the breast intact with the nipple attached to protect the blood supply to the nipple. Without adequate blood flow, the nipple dies. That is a bad thing. So we cant just shell everything out. If we then elevate the muscle to place an implant in behind, this can compromise the blood supply and result in a disaster. Also, it would be difficult to shape the breast.

Now, I can, after the breast is well healed, perform a breast augmentation behind a previously reduced breast to increase upper pole fullness. This isnt a very common request because the last thing most reduction patients want is to get that weight back on their chest but it has been done.

Lee Corbett, MD

In my Louisville Plastic Surgery practice, I see a lot of women with very large breasts seeking a Louisville, KY breast reduction. Unfortunately, it seems the insurance companies are moving away from covering these procedures.

Just recently one of the main insurers in our market added the requirement that the women who complain of upper back pain must have a full evaluation by a spine surgeon AND a complete spine X-ray, CT scan or MRI. I think this is idiotic. They are forcing the patient to waste her time and the spine surgeon’s time. They are wasting money on Dr. visits and very expensive X-rays, not to mention that spine X rays and CT scans expose the patients unnecessarily to a lot of radiation.

So, in classic form, they will gladly cash your premium payment checks but god forbid you try and use your insurance.

I’ll get off my soapbox now.

Lee Corbett, MD

In my Louisville Kentucky Cosmetic surgery practice I encounter this complaint frequently. And that is no great surprise becasue every woman’s breasts are uneven.

When a woman is considering a Louisville Breast Augmentation, I will frequently use different volumes to account for the asymmetry or even different style implants. I tackle the size problem  by using implant sizers. These are trial implants that we place and then fill to different volumes to see what balances things out. They only run $30 or $40 which is a lot better than trialing a $1000 silicone implant only to find its the wrong size!!

When I do Louisville Breast Lifts or Louisville Breast Reductions, I can simply remove more tissue from the larger breast to balance things out.

What is more difficult to correct is if the breasts are vertically asymmetric. It is hard to adjust the breast crease a lot so these asymmetries tend to persist. Likewise, if your rib cage is different from side to side, there is very little to do.

Lee Corbett, MD

all posts on this blog are presented by Louisville Cosmetic Surgeon, Dr. Lee Corbett

Here in my Louisville Plastic Surgery office we are seeing our usual “Spring Rush”.  More than ever, it seems like patients are wanting to do more than one operation simultaneously. Common examples are a Louisville facelift with a blepharoplasty or a Louisville Breast Reduction with a Lousiville Tummy Tuck.

My opinion on combining procedures is based on many factors. First, I look at your overall health status. Secondly, I look at the scope of the procedures we are planning and their physiological impact, and finally we need to consider how much time it will take to get you in and out of the O.R.

My advice is to come in for a consultation, let me see your “wish list”, then we’ll take a look at your starting point. I can then map out a plan and we can then decide the feasability. Our consultations are complimentary.

Lee Corbett, MD

Louisville KY. Cosmetic Plastic Surgeon

When I meet a new patient considering a Louisville Breast Augmentation, a Louisville Breast Lift or a Louisville Breast Reduction they often share a common misconception. That is, after one of the aforementioned procedures, their breast tissue will change. This isn’t the case.

After an augmentation the breast will be larger. The upper volume will be restored. Droop can be corrected. BUT…the breast tissue that sits on top of the implant is still the same breast tissue you started with. It will not become firmer. The skin will not change. Stretch marks will not go away etc…

The same is true for a reduction or lift. These are great operations because they work! But, again, the nature and consistency of the breast tissue itself is unchanged.

Lee Corbett, MD

All posts on this blog are presented by Louisville Plastic Surgeon Dr. Lee Corbett.

Nipple size following a Louisville Breast Lift or Louisville breast reduction can be tricky.

Typically when these operations are done, the areola, the pigmented skin around the nipple, is downsized.

We do this by using a circular metal instrument, a “cookie cutter”,  that centers over the nipple. They come in different sizes, usually 38mm, 42mm, or 45mm. We then mark the skin around the cookie cutter and make the cut along the lines.

The problem is that the skin is usually cold from being exposed.  This causes the nipple to become erect and the skin of the areola contracts. If this happens differentially, it will leave the areolae different sizes after the skin relaxes and warms.

These problems are easy to fix and can be taken care of in the office.

Lee Corbett, MD

The areola is the pigmented skin on the breast that surronds the nipple. It is not uncommon for the areola to enlarge with weight gain and/or pregnancy and some women just have large areola.

The “normal” areola is about 42mm in diameter or about 2 inches wide. There are a lot of women with areolae larger than this who do not like this appearance.

This problem can be easily addressed as part of a Breast Augmentation, Breast Lift, Breast Reduction or as a stand alone procedure. What we do is place what is called a cookie cutter over the nipple. This is a metal circle that is 38 to 45 mm in diameter. We center it over the nipple and press down (you are asleep) and then mark the circle. We then make an incision along our mark and a second one along the natural areolar border. The excess areola is then removed and the outer circle is sewn closed to the inner circle. You now have a smaller areola.

If done alone, this can be performed in the office under local anesthesia. When part of one of the other procedures, it will be done in the O.R.

Lee Corbett, MD

All posts on this blog are presented by Louisville Breast Enlargement Surgeon, Dr. Lee Corbett.

There is no doubt that having a Louisville Breast Reduction will affect future breast feeding.

When we do a breast reduction, the breast is truly ‘dis-assembled’. Typically a segment of the breast which supports the blood supply to nipple remains undisturbed. This segment we call the ‘pedicle’. The tissue around the pedicle is then removed to effect the reduction. When we do this the milk duct system is disrupted to some degree and this is the problem. The breast that we leave behind will still make milk after the pregnancy, but the question is will it make it to the nipple to feed the baby.

I have read studies that reported interference with breast feeding running as high as 80% after a reduction. This is what I quote my patients when they consult. If breast feeding is really important to you, you may want to wait until after you have had all your kids.

Lee Corbett, MD

All posts on this blog are presented by Kentucky Breast Reduction surgeon, Dr. Lee Corbett

Insurance coverage for a Louisville Breast Reduction is dependant upon several factors.

First, there must be an element of medical necessity. In other words, you have to have symptoms. They want to know if you have a history of neck, shoulder or upper back pain, shoulder grooving, or rashes under or between your breasts. Insurance companies do not care if you can’t buy a bathing suit, if you are self-conscious, or can’t exercise.

The second critical factor is how much weight we predict can be removed from your breast. The minimum amount is determined by your height and weight. These two numbers are plugged into a formula and out comes a number called your Body Surface Area. For each BSA there is a corresponding amount of breast tissue that must be removed. Since your height doesn’t change, what this means is that the more your body weight, the more we have to remove.

It seems to change all the time, but at least for today, if you have symptoms and we can get enough off to satisfy the BSA chart, you will probably have coverage.

Lee Corbett, MD


All posts on this blog are presented by Louisville Breast Reduction expert, Dr. Lee Corbett.

Breast reductions and Breast lifts are very similar operations. In a lot of cases the incisions are similar, both serve to lift the breast and re-position the nipple. But there are some significant differences.

The reasons women seek the operations differ. Both want their breasts lifted but reduction patients also tend to complain of neck, shoulder, and upper back discomfort. They also complain of shoulder grooving and of developing rashes under their breasts.

The obvious is that reductions significantly downsize the breast. I don’t know that there is an average, but most women will drop 2 or 3 cup sizes after a reduction. After a lift, most women experience a slight decrease in their bra size. In fact, a lot of times women who have lifts elect to have an implant placed in order to re-establish the fullness at the top portion of their breasts.

Finally, reductions tend to be considered medically necessary and covered by insurance. Lifts are considered cosmetic and financial responsiblity lies solely with the patient.

Lee Corbett, MD


All posts on this blog are authored by Kentucky Plastic Surgeon, Dr. Lee Corbett. Dr. Corbett specializes in cosmetic plastic surgery including facelifts, browlifts, blepharoplasy, Botox, Juvederm, Restylane, breast augmentation, breast lifts, breast reductions, body lifts, liposuction,  and tummy tucks.